A team of researchers including Professor Marian Knight MBE from Oxford Population Health’s National Perinatal Epidemiology and Unit and Dr Raph Goldacre from the University of Oxford’s Big Data Institute, along with NHS anaesthetic consultant colleagues based in Cambridge, Harrow, and Coventry, have found that there may be inequalities linked to ethnicity and the type of anaesthetic care that is provided to women while giving birth. The results are published in Anaesthesia.
Minority ethnic women in the UK have previously reported poorer experiences of maternity care when compared with white women but this is the first published study to analyse the relationship between ethnicity and obstetric anaesthetic care.
The researchers analysed routine maternity data from the national Hospital Episode Statistics Admitted Patient Care (HES APC) database. This included 6,032,425 childbirth records belonging to 4,180,887 women aged under 55 who lived in England. The records included in the study related to births that occurred between 1 March 2011 and 28 February 2021. Ethnic groups were defined according to the data recorded by the hospitals. Variables such as differences in maternal age, geographical area, deprivation levels, admission year, previous births, and comorbidities were taken into account when analysing the data.
Key findings:
- For women who gave birth via an elective (or ‘planned’) caesarean section, Caribbean (Black or Black British) women were 58% more likely to be given a general anaesthetic compared to white women (adjusted incidence ratio 1.58 95% CI [1.26 – 1.97]). African (Black or Black British) women were 35% more likely to be given a general anaesthetic for an elective caesarean section when compared to British white women (1.35 [1.19 – 1.52]);
- For women who had emergency caesarean sections, Caribbean (Black or Black British) women were 10% more likely to be given a general anaesthetic (1.10 [1.00 – 1.21]) than white British women;
- For women who gave birth vaginally, excluding assisted vaginal births, Bangladeshi (Asian or Asian British), Pakistani (Asian or Asian British), and Caribbean (Black or Black British) were, respectively, 24% (0.76 [0.74 – 0.78]), 15% (0.85 [0.84 – 0.87]), and 8% (0.92 [0.89 – 0.94]) less likely to receive neuraxial anaesthesia than white British women.
Marian Knight, Professor of Maternal and Child Population Health, said ‘Our study used observational data and so we were unable to determine the cause for the disparities that were identified. The findings clearly demonstrate a need for further research to investigate factors that may be driving the disparities, such as inequality of access to appropriate obstetric anaesthetic care.
‘We must ensure that any differences in obstetric anaesthetic care are not due to inequities in the access, delivery or quality of care and not assume that they are related to personal or cultural preferences. To ensure that obstetric anaesthetic care is equitable, information on anaesthetic choices needs to be easily accessible. Women from ethnic minorities must be listened to better to avoid misconceptions and presumptions about their expectations and experiences of perinatal care.’